Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes

Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. M...
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Autor*in:	Orcutt, Sonia T. [verfasserIn] Massarweh, Nader N. [verfasserIn] Li, Linda T. [verfasserIn] Artinyan, Avo [verfasserIn] Richardson, Peter A. [verfasserIn] Albo, Daniel [verfasserIn] Anaya, Daniel A. [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2016

Schlagwörter:	Veteran Affair Colorectal Liver Metastasis Trend Test Ablative Therapy Current Procedural Terminology

Übergeordnetes Werk:	Enthalten in: Annals of surgical oncology - Berlin [u.a.] : Springer, 1994, 24(2016), 1 vom: 24. Juni, Seite 23-30
Übergeordnetes Werk:	volume:24 ; year:2016 ; number:1 ; day:24 ; month:06 ; pages:23-30

Links:	Volltext

DOI / URN:	10.1245/s10434-016-5351-8

Katalog-ID:	SPR009983155

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520			\|a Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures.
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700	1		\|a Anaya, Daniel A. \|e verfasserin \|4 aut
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Indexfelder

author_variant	s t o st sto n n m nn nnm l t l lt ltl a a aa p a r pa par d a da d a a da daa
matchkey_str	article:15344681:2016----::atrsfaeoclrcalvreatssihnnnertdelhytm
hierarchy_sort_str	2016
bklnumber	44.81 44.65
publishDate	2016
allfields	10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30
spelling	10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30
allfields_unstemmed	10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30
allfieldsGer	10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30
allfieldsSound	10.1245/s10434-016-5351-8 doi (DE-627)SPR009983155 (SPR)s10434-016-5351-8-e DE-627 ger DE-627 rakwb eng 610 ASE 44.81 bkl 44.65 bkl Orcutt, Sonia T. verfasserin aut Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures. Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213 Massarweh, Nader N. verfasserin aut Li, Linda T. verfasserin aut Artinyan, Avo verfasserin aut Richardson, Peter A. verfasserin aut Albo, Daniel verfasserin aut Anaya, Daniel A. verfasserin aut Enthalten in Annals of surgical oncology Berlin [u.a.] : Springer, 1994 24(2016), 1 vom: 24. Juni, Seite 23-30 (DE-627)343969947 (DE-600)2074021-9 1534-4681 nnns volume:24 year:2016 number:1 day:24 month:06 pages:23-30 https://dx.doi.org/10.1245/s10434-016-5351-8 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2039 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2070 GBV_ILN_2086 GBV_ILN_2088 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2116 GBV_ILN_2118 GBV_ILN_2119 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.81 ASE 44.65 ASE AR 24 2016 1 24 06 23-30
language	English
source	Enthalten in Annals of surgical oncology 24(2016), 1 vom: 24. Juni, Seite 23-30 volume:24 year:2016 number:1 day:24 month:06 pages:23-30
sourceStr	Enthalten in Annals of surgical oncology 24(2016), 1 vom: 24. Juni, Seite 23-30 volume:24 year:2016 number:1 day:24 month:06 pages:23-30
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Veteran Affair Colorectal Liver Metastasis Trend Test Ablative Therapy Current Procedural Terminology
dewey-raw	610
isfreeaccess_bool	false
container_title	Annals of surgical oncology
authorswithroles_txt_mv	Orcutt, Sonia T. @@aut@@ Massarweh, Nader N. @@aut@@ Li, Linda T. @@aut@@ Artinyan, Avo @@aut@@ Richardson, Peter A. @@aut@@ Albo, Daniel @@aut@@ Anaya, Daniel A. @@aut@@
publishDateDaySort_date	2016-06-24T00:00:00Z
hierarchy_top_id	343969947
dewey-sort	3610
id	SPR009983155
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">SPR009983155</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230519081131.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">201005s2016 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1245/s10434-016-5351-8</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)SPR009983155</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(SPR)s10434-016-5351-8-e</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">ASE</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.81</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.65</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Orcutt, Sonia T.</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2016</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. 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author	Orcutt, Sonia T.
spellingShingle	Orcutt, Sonia T. ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
authorStr	Orcutt, Sonia T.
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topic_title	610 ASE 44.81 bkl 44.65 bkl Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes Veteran Affair (dpeaa)DE-He213 Colorectal Liver Metastasis (dpeaa)DE-He213 Trend Test (dpeaa)DE-He213 Ablative Therapy (dpeaa)DE-He213 Current Procedural Terminology (dpeaa)DE-He213
topic	ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology
topic_unstemmed	ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology
topic_browse	ddc 610 bkl 44.81 bkl 44.65 misc Veteran Affair misc Colorectal Liver Metastasis misc Trend Test misc Ablative Therapy misc Current Procedural Terminology
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hierarchy_parent_title	Annals of surgical oncology
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title	Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
ctrlnum	(DE-627)SPR009983155 (SPR)s10434-016-5351-8-e
title_full	Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
author_sort	Orcutt, Sonia T.
journal	Annals of surgical oncology
journalStr	Annals of surgical oncology
lang_code	eng
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author_browse	Orcutt, Sonia T. Massarweh, Nader N. Li, Linda T. Artinyan, Avo Richardson, Peter A. Albo, Daniel Anaya, Daniel A.
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author-letter	Orcutt, Sonia T.
doi_str_mv	10.1245/s10434-016-5351-8
dewey-full	610
author2-role	verfasserin
title_sort	patterns of care for colorectal liver metastasis within an integrated health system: secular trends and outcomes
title_auth	Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
abstract	Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures.
abstractGer	Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures.
abstract_unstemmed	Background Utilization of evidence-based treatments for patients with colorectal liver metastasis (CRC-LM) outside high-volume centers is not well-characterized. We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. Older patients [65–75 years: odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.39–1.97; >75 years: OR 3.84, 95 % CI 3.13–4.69] and those with high comorbidity index (Charlson ≥3: OR 1.47, 95 % CI 1.16–1.85) were more likely to be untreated. Overall survival was significantly different based on treatment strategy (log-rank p < 0.001). Conclusions The proportion of CRC-LM patients receiving treatment within the largest integrated health system in the US (VA health system) has increased substantially over time; however, one in three patients still does not receive any treatment. Future initiatives should focus on increasing treatment among older patients as well as on evaluating reasons leading to the no-treatment approach and increased use of ablation procedures.
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container_issue	1
title_short	Patterns of Care for Colorectal Liver Metastasis Within an Integrated Health System: Secular Trends and Outcomes
url	https://dx.doi.org/10.1245/s10434-016-5351-8
remote_bool	true
author2	Massarweh, Nader N. Li, Linda T. Artinyan, Avo Richardson, Peter A. Albo, Daniel Anaya, Daniel A.
author2Str	Massarweh, Nader N. Li, Linda T. Artinyan, Avo Richardson, Peter A. Albo, Daniel Anaya, Daniel A.
ppnlink	343969947
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isOA_txt	false
hochschulschrift_bool	false
doi_str	10.1245/s10434-016-5351-8
up_date	2024-07-04T03:47:02.463Z
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We sought to describe trends in treatment and outcomes, and identify predictors of therapy within a nationwide integrated health system. Methods Observational cohort study of patients with CRC-LM treated within the Veterans Affairs (VA) health system (1998–2012). Secular trends and outcomes were compared on the basis of treatment type. Multivariate regression was used to identify predictors of no treatment (chemotherapy or surgery). Results Among 3270 patients, 57.3 % received treatment (chemotherapy and/or surgery) during the study period. The proportion receiving treatment doubled (38 % in 1998 vs. 68 % in 2012; trend test, p < 0.001), primarily driven by increased use of chemotherapy (26 vs. 57 %; trend test, p < 0.001). Among patients having surgery (16 %), the proportion having ablation (10 vs. 61.9 %; trend test, p < 0.001) and multimodality therapy (15 vs. 67 %; trend test, p < 0.001) increased significantly over time. 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